HEALTHCARE DESIGN.09 educational session: Capturing Proactive Construction Risk Assessments Costs in Planning and Design

Presenter: Michael Chihoski, MS, CHFM, CHSP, SASHE, Senior Vice-President, Corporate Engineering Division, OSF Healthcare System; and John Martinelli, CIAQM, CMC, CAC, Director, Northern California Environmental Health Consulting Services, Forensic, Analytical Consulting Services, Inc.

In Michael Chihoski and John Martinelli’s presentation, they discussed the need for collaboration and multidisciplinary participation in risk assessment, referred to as proactive construction risk assessment (PCRA). One of the most important aspects of PCRA, they noted, was the inclusion and input of all people that the construction may affect. PCRA, along with the standards and guidance of organizations like APIC, the CDC, Joint Commission, and AIA Guidelines for Design and Construction of Hospitals and Health Care Facilities should help remove nearly all risks in the construction phase.

One telling example they used was, when renovating next to a NICU, the team believed that prolonged noise from the construction would have a significant negative effect on the babies in the NICU and had determined to work in 15-minute intervals. Before proceeding, however, they consulted the physicians who said that would be the worst method for the situation. The physician explained that the real danger is in startling the children in the NICU, and the stop-and-start method they proposed would be dangerous for the patients. Instead, the physician said, the team should work nonstop until the construction is done to avoid startling the children.

Among other examples, Chihoski and Martinelli outlined the importance of dust control, work practices, and administrative controls. In terms of dust control and air quality, they suggested barrier systems, to isolate the HVAC system, establish air pressure differential—and to be wary of changing the air pressure of the facility through reckless construction—having walk-off mats, and areas for hand washing. One recommendation they stressed, however, was that you should do enough to control the hazard but shouldn’t over do it.

Important work practices to prevent infection risk include protective clothing, proper training, and adequate cleaning. As for administrative controls, they stressed that designated routes—front of house versus back of house paths—were important; it is critical not to have patients and visitors accidentally walk into a construction zone; wayfinding plays a major role in reducing such risks. Correct material storage is also an important factor. For example, if drywall is improperly stored and gets wet before it’s installed, it will result in mold in the future. And communication concerning the construction process and timeline is similarly important so that physicians can plan for any disruption that may occur on a regular basis. For those that don’t, it is critical that there is no loss of utilities.

This extremely integrated process can only be achieved in full through a multidisciplinary approach like proactive construction risk assessment.